Phlegmonous Gastritis With Streptococcal Toxic Shock Syndrome: A Rare Complication After Endoscopy

Phlegmonous gastritis is a rare, suppurative bacterial infection of the gastric wall and one of the rarest complications after upper gastrointestinal endoscopy. The pathogenesis is not fully clear, but multiple risk factors have been described in literature as mucosal injury and achlorhydria. We report a case of a 76-year-old male with vomiting and epigastric pain, two days after an upper endoscopy, who presented in septic shock. The diagnostics with computed tomography showed diffuse thickening of the gastric wall, and the differential diagnosis of phlegmonous gastritis was made. Subsequently, he developed abdominal compartment syndrome and clinically deteriorated, necessitating open partial gastric resection. This case of a rare complication after upper gastrointestinal endoscopy with a potentially fatal outcome illustrates septic shock and abdominal compartment syndrome as severe complications. In this case, a combination of early antibiotic treatment and calculated surgical interventions showed a favorable outcome. Only a limited number of cases of phlegmonous gastritis after endoscopy have been published, and to the best of our knowledge, this is the second case of phlegmonous gastritis with subsequent abdominal compartment syndrome as a complication.